Neighborhood Context as a Barrier to Sport Participation for Girls: Evidence From a Sport Diversity Index.

BACKGROUND: Evidence suggests neighborhood contexts play a vital role in shaping the availability and diversity of youth sport and participation rates, especially for African American or Black girls. Currently, no index captures interscholastic sport opportunities (eg, sport diversity) within and across school districts and specifically applied to African American or Black girls. OBJECTIVE: To visualize the inequalities present in interscholastic sport opportunities for girls across school districts using a novel index in a selected study area of St Louis City and County, Missouri, and discuss the implications for African American or Black girls. DESIGN: Cross-sectional study. SETTING: Database secondary analysis. PATIENTS OR OTHER PARTICIPANTS: Data for 47 public high schools in the 23 St Louis City and County school districts. MAIN OUTCOME MEASURE(S): We gathered data from the 2014-2018 American Community Survey and Missouri State High School Activities Association. We assessed sport diversity for girls by constructing a sport diversity index (SDI) that uses an entropy index as its foundation. Census-tract data were used to examine the association with neighborhood demographics and contributors to school district income and sport diversity. Descriptive spatial statistics were calculated to evaluate distributions in St Louis City and County, with the bivariate local indicator of spatial autocorrelation used to determine any correlations between variables of interest. RESULTS: The St Louis City school district, which has areas with high rates of renter-occupied housing and poverty and high percentages of non-Hispanic African American or Black students, had the lowest SDI for girls, contrasted with the school districts in St Louis County, which showed an inverse pattern on average. The SDI for girls was correlated with the percentages of renter-occupied housing and poverty. The SDI for girls was also correlated with race: an increasing presence of the non-Hispanic African American or Black population was associated with decreased sport diversity for girls. CONCLUSIONS: The SDI for girls demonstrated a spatial association with neighborhood-level determinants of sport-opportunity availability for non-Hispanic African American or Black girls in St Louis. The role of social and political determinants of health in shaping community context and resultant health in athletic training research, policy, and practice should be considered.

An exploration of the cultural appropriateness of the family-centered function-focused care intervention.

The Family-centered Function Focused Care (Fam-FFC) intervention, is a nurse-family care partnership model aimed to improve the physical and cognitive recovery in hospitalized persons living with Alzheimer's Disease Related Dementias (ADRD) while improving the care partner's experiences. Discussions of patients' needs and preferences between nurses and the patient's close family members have been found to be useful in preventing excessive stress in persons with dementia, while lessening the anxiety of care partners. However, the efficacy of dementia-specific interventions is influenced in part by the degree to which the interventions are flexible and sensitive to the patient's and care-partner's condition, needs, and preferences, including cultural preferences. Therefore, the purpose of this study is to assess the cultural appropriateness of Fam-FFC using the Ecological Validity Model (EVM). This qualitative, descriptive study included 28 consented care partners drawn from a sample of 455 dyads enrolled in the Fam-FFC intervention. An interview guide was created based on the EVM. Participants provided demographic data. Thematic analysis was conducted to analyze transcribed interviews. The majority of the sample was female (79%), Non-Hispanic (96%) and half were married. One-half of the sample represented Black care partners and one-half were White. Seventy-nine percent lived with their family member with ADRD. Three major themes were identified from the thematic analysis including Care Partner Identity, Care Partner Preferences, and Goals of Care for functional recovery of their family member living with dementia. In this study care partners wanted more social services as well as home care that supported not just physical needs but also social and recreational needs. Findings from the study offer guidance on improving the Fam-FFC intervention including strengthening education and resources on partner self-care.

Preconception health indicators among adult US men: Race/ethnicity variations and temporal trends.

BACKGROUND: Preconception health is important for men as it is for women. However, optimizing preconception health is understudied among men. OBJECTIVES: To examine the time trends and temporal shifts in preconception health risk indicators among 20-44-year-old adult US men in need of preconception care and their racial/ethnic variations. MATERIALS AND METHODS: Data from the 2011-2019 National Survey of Family Growth male file was used to estimate the prevalence of nine preconception health indicators among men (20-44 years) intending to have a future pregnancy (n = 6813), stratifying by race/ethnicity, and assessing temporal changes across the study period. Binary logit and linear regression models estimated temporal trends from 2011-2013 to 2017-2019. Absolute and relative changes were estimated to detect temporal shifts in men's preconception health comparing 2011-2013 to 2017-2019. RESULTS: Men in all groups exhibited substantial preconception health needs, with unique trends across race/ethnicity groups. Between 2011 and 2019, the prevalence of marijuana use (28.6%-39.4%, p = 0.001), overweight/obese status (60.7%-65.1%, p ≤ 0.001), and the mean number of preconception health indicators (M = 2.69-2.84, p = 0.018) increased. Among non-Hispanic White men, the prevalence of marijuana use (30.1%-41.4%, p = 0.028), overweight/obese status (60.6%-63.7%, p = 0.002), and mean number of preconception health risk indicators (M = 2.74-2.90, p = 0.033) increased. Among Hispanic men, the prevalence of inconsistent/no condom use (68.9%-81.4%, p = 0.022), marijuana use (18.9%-40.4%, p = 0.001), and the mean number preconception health risk indicators (M = 2.50-2.96, p = 0.014) increased. Among non-Hispanic Black men, sexually transmitted infections declined (5.4%-3.6%, p = 0.002). Significant temporal shifts, which varied by race/ethnicity, were also observed. DISCUSSION AND CONCLUSION: Our study, which provides initial insight into men's preconception health development in the last decade, highlights a tremendous need for preconception health care among men. Their increasing preconception health needs, and their racial/ethnic variations, suggest additional contributors to racial/ethnic differences in men's reproductive outcomes and their long-term health.

Testing an Intervention to Improve Posthospital Outcomes in Persons Living With Dementia and Their Family Care Partners.

Background and Objectives: Hospitalized persons living with dementia are at risk for functional decline, behavioral symptoms of distress, and delirium, all persisting in the postacute period. In turn, family care partners (FCPs) experience increased anxiety and lack of preparedness for caregiving, compounding existing strain and burden. Family-centered Function-focused Care (Fam-FFC) purposefully engages FCPs in assessment, decision-making, care delivery, and evaluation of function-focused care during and after hospitalization (within 48 hours of discharge, weekly telephone calls for a total of 7 additional weeks, then monthly for 4 months). The objective of this study was to test the efficacy of Fam-FFC. Research Design and Methods: A cluster randomized controlled trial included 455 dyads of persons living with dementia and FCPs in 6 medical units in 3 hospitals. Patient outcomes included return to baseline physical function, behavioral symptoms of distress, depressive symptoms, and delirium severity. Family care partner measures included preparedness for caregiving, anxiety, strain, and burden. Results: Multilevel level modeling demonstrated that the likelihood of returning to baseline function across time for Fam-FFC participants was twice that of the control group by the end of 6 months (OR = 2.4, p = .01, 95% CI 1.2-4.7). Family-centered Function-focused Care was also associated with fewer symptoms of distress (b = -1.1, SE = 0.56, p = .05) but no differences in the amount of moderate physical activity, depressive symptoms, and delirium severity. Preparedness for caregiving increased significantly only from 2 to 6 months (b = 0.89, SE = 0.45, d = 0.21, overall p = .02) in the intervention group, with no group differences in anxiety, strain, and burden. Discussion and Implications: Family-centered Function-focused Care may help prevent some of the postacute functional decline and behavioral symptoms in hospitalized persons living with dementia. Further research is needed to promote sustained improvements in these symptoms with more attention to the postacute needs of the care partner.

Caregiver preparedness is associated with desire to seek long-term care admission of hospitalized persons with dementia.

INTRODUCTION: Hospitalized patients with dementia are more likely to be discharged to long-term care compared to persons without dementia. Little research has been conducted to examine the associations of caregiver preparedness and strain with desire to seek long-term care in hospitalized persons with dementia at discharge. The purpose of this study was to examine caregiver preparedness and strain as factors associated with desire to seek long-term care admission in caregivers of persons with dementia at hospital discharge. METHODS: Patient baseline and discharge data, and caregiver discharge data of 424 patient and caregiver dyads from a cluster randomized trial was used. Stepwise multiple linear regression was conducted to examine factors associated with caregiver desire to seek long-term care. RESULTS: After controlling for caregiver and patient characteristics, lower caregiver preparedness (ß = -0.069; p < 0.016) was significantly associated with increased desire to seek long-term care. DISCUSSION: Findings underscore the need for clinicians and service providers to provide further attention to caregiver preparedness throughout the course of hospitalization.

Clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia.

This study examines the clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia. Following examination of bivariate associations, we conducted multiple linear regression in a sample of 140 hospitalized older patients with dementia who participated in the final cohort of an intervention study implementing Family-centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29) and had positive interactions with staff (mean QUIS score = 5.84, SD = 1.36). Accounting for 17.8% of variance in the model, non-pharmacological intervention use (b= 0.170; p<.001) and pain (b= -0.198; p<.01) were significantly associated with the quality of staff-patient interactions. To optimize care of hospitalized patients with dementia, staff should be encouraged to use non-pharmacological interventions. It is also important for staff to assess pain among the patients with dementia and prioritize pain management.

Digital HPV education to increase vaccine uptake among low income women.

Objective: The objective of this formative study was to gather women's perspectives in the design and communication modalities of a health kiosk set within a Planned Parenthood setting to promote patient education about the Human papillomavirus (HPV) and to motivate uptake of the HPV vaccine. Methods: Twenty-four women aged 18-35 participated in in-depth one-on-one interviews at a Planned Parenthood health center, which were analyzed in code-associated categories using NVivo11 Pro. Results: Most women showed receptivity to using an on-site health kiosk, as well as QR codes linked to text messages, to receive HPV-related health information outside of the clinic setting and reminders. Participants provided suggestions for kiosk design and communication modalities. Conclusions: Among low-income women we interviewed at Planned Parenthood, increasing HPV vaccination rates necessitates engaging digital health tools which incorporate both the preferences and needs of vulnerable populations. Innovation: Designing a point-of-service health kiosk that 1) draws on user preferences early in the design phase, 2) integrates multiple communication technologies, and 3) disseminates culturally grounded HPV vaccination decisions narratives that are tailored to vaccination awareness level is a promising approach in reducing barriers to HPV vaccine education and vaccine uptake among low-income women at safety-net clinics.

Tracking adaptation strategies of an HIV prevention intervention among youth in Nigeria: a theoretically informed case study analysis of the 4 Youth by Youth Project.

BACKGROUND: Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth. METHODS: The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications - Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria-an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals. RESULTS: Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention's feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group. CONCLUSIONS: Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement.

Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project.

BACKGROUND/AIMS: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS: Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission: Mediating Factors.

BACKGROUND: Hospitalized persons with dementia are at risk of delirium with behavioral symptoms, predisposing them to a higher rate of complications and caregiver distress. The purpose of this study was to examine the relationship between delirium severity in patients with dementia upon admission to the hospital and the manifestation of behavioral symptoms, and to evaluate the mediating effects of cognitive and physical function, pain, medications, and restraints. METHODS: This descriptive study used baseline data from 455 older adults with dementia enrolled in a cluster randomized clinical trial that tested the efficacy of family centered function-focused care. Mediation analyses were conducted to determine the indirect effect of cognitive and physical function, pain, medications (antipsychotics, anxiolytics, sedative/hypnotics, narcotics, and number of medications), and restraints on behavioral symptoms, controlling for age, sex, race, and educational level. RESULTS: The majority of the 455 participants were female (59.1%), had an average age of 81.5 (SD=8.4), were either white (63.7%) or black (36.3%), and demonstrated one or more behavioral symptoms (93%) and delirium (60%). Hypotheses were partially supported in that physical function, cognitive function, and antipsychotic medication partially mediated the relationship between delirium severity and behavioral symptoms. CONCLUSION: This study provides preliminary evidence identifying antipsychotic use, low physical function, and significant cognitive impairment as specific targets for clinical intervention and quality improvement in patients with delirium superimposed on dementia at hospital admission.

The Modified Caregiver Strain Index in Black and White Dementia Caregivers at Hospital Discharge.

OBJECTIVES: This study aimed to examine psychometric properties of the Modified Caregiver Strain Index (MCSI) in Black and White caregivers of persons living with dementia at hospital discharge. METHODS: This was a cross-sectional study using baseline data of 423 family caregivers recruited from a cluster randomized clinical control trial. Factor structure, measurement invariance, and concurrent validity of the MCSI were analyzed. The moderating role of race on the relationship between MCSI score and anxiety, depression, and burden was also examined. RESULTS: The two-factor model fits the data best and was invariant across race. Regarding concurrent validity, higher MCSI scores were significantly associated with higher scores on the (HADS-A; anxiety), (HADS-D; depression), and (ZBI; burden). Race moderated the relationship between MCSI score and anxiety, depression, and burden. CONCLUSIONS: The MCSI is a valid tool to assess caregiver strain in Black and White caregivers of persons living with dementia during hospital discharge. Results suggest that the effect of MCSI score on anxiety, depression, and burden varies by race. CLINICAL IMPLICATIONS: MCSI can be used by clinicians and service providers to help support the needs of Black and White caregivers of people living with dementia during post-hospital transition.

Using Collective Impact to Develop a Community-Led Initiative for Improving Black Infant Mortality.

The United States has one of the highest infant mortality rates among developed countries. When stratified by race, disparities are more evident: Black infant mortality rates are 2.5 times higher than non-Hispanic white infants. Structural, systemic racism is a contributing cause for these racial disparities. Multisector collaborations focused on a common agenda, often referred to as collective impact, have been used for infant mortality reduction interventions. In addition, community-based participatory approaches have been applied to incorporate those with lived experience related to adverse pregnancy outcomes. This article critically describes the transition of an infant mortality collective impact initiative from being led by a multisector organizational group to being community led over a 5-year period, 2015-2020. A 34-member community leaders group was developed and determined four priorities and corresponding strategies for the initiative. Findings show that community participatory approaches are a way to address racial equity for public health initiatives.

Gender differences in interactions and depressive symptoms among hospitalized older patients living with dementia.

Alzheimer's disease or a related dementia (ADRD) disproportionately affects women with two-thirds of individuals with ADRD comprised of women. This study examined gender-related differences in the quality of staff-patient interactions and depressive symptoms among hospitalized older patients living with dementia. This secondary analysis utilized baseline data of 140 hospitalized older patients with dementia who participated in the final cohort of a randomized controlled trial (ClinicalTrials.gov identifier: NCT03046121) implementing Family centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29), had positive interactions with staff and lower depressive symptoms based on Quality of Interaction Schedule (QUIS) scores and Cornell Scale for Depression in Dementia (CSDD) scores, respectively. Although males had more positive interactions (male = 6.06, SD = 1.13; female = 5.59, SD = 1.51) and lesser depressive symptoms (male = 7.52, SD = 4.77; female = 8.03, SD = 6.25) than females, no statistically significant gender differences were observed in linear models with appropriate covariates or multivariant analysis of covariant (MANCOVA). However, the multigroup regression conducted to further probe marginally significant moderation effect of gender and pain on staff-patient interactions demonstrated that greater pain was significantly related to lower quality or less positive staff-patient interactions for females compared to males (χ2diff (1) = 4.84, p = .03). Continued evaluation of gender differences is warranted to inform care delivery and interventions to improve care for hospitalized older patients with dementia.

Men's Preconception Health and Fertility Intentions: A Latent Class Analysis Approach.

Men's pregnancy intention is associated with a host of positive outcomes for families, yet this topic remains understudied. Because unintended pregnancies are more likely to occur at suboptimal parental health, this study aimed to examine the extent to which men improve their preconception health in the context of future fertility planning. This study used pooled data from the 2011-2019 National Survey of Family Growth for a final sample size of 10,223. Latent class analysis (LCA) was used to identify distinct classes of men's preconception health. Eight preconception health risk factors were used to determine class membership. A classify-analyze approach was used to create the preconception health phenotype (PhP) exposure variable. The outcome of interest was men's fertility intentions. Multinomial regression models were used to examine the association between the exposure and the outcome. Three unique PhPs were identified (lowest risk, substance users, and sexual risk-takers) from the LCA model. Men in the substance users' group (22.9%) were characterized by high-risk alcohol use and drug use, while sexual risk-takers (8.1%) were characterized by having multiple sexual partners. Belonging in the phenotypes of substance users or sexual risk-takers was associated with increased odds for definite no fertility intention than definite yes intentions (adjusted odds ratio [aOR]: 1.47, 95% confidence interval [CI]: [1.18, 1.84] and aOR: 1.51, 95% CI: [1.13, 2.01], respectively). Results provide new insights on how preconception health can be measured and fills a knowledge gap on its relationship to men's future fertility planning. Findings can be applied to preconception care intervention frameworks, and guide family planning interventions and contraceptive counseling.

Structural and health system determinants of health outcomes in systemic lupus erythematosus: Understanding the mechanisms underlying health disparities.

Chronic diseases are increasingly responsible for the burden of health outcomes across the world. However, there is also increasing recognition that patterns of chronic disease outcomes (e.g., mortality, quality of life, etc.) have inequities across race, gender, and socioeconomic groups that cannot be solely attributed to these determinants. There is a need for an organizing framework which centers fundamental causes of health disparities that may better guide future work in centering these mechanisms and moving beyond acknowledgment of health disparities. In this paper, we synthesize several concepts from health disparities literature into a conceptual framework for understanding the interplay of patients' lived experiences, the health care system and structural determinants. Our framework suggests that (1) structural factors influence the health care system, the patient, the health care provider, and the provider-patient relationship through process of subordination and (2) that structurally competent actions are critical to reducing health inequities. The addition of subordination to theoretical frameworks involving health equity and social determinants of health, along with engagement with concepts of structural competency suggest several systems level changes to improve health outcomes.

Men's preconception health and the social determinants of health: What are we missing?

Background: Life course perspectives suggest that optimizing men's health before conception is requisite to equitably improve population health, an area of increasing public health focus. Although scholarship on the social determinants of health (SDOH) suggests that men's health and health behaviors do not occur in a vacuum, preconception health studies have not explicitly examined how these factors influence men's preconception health. Objective: To identify latent classes of men's preconception health and the role of the SDOHs in predicting class membership. Methods: Pooled data from the 2011-2019 male file of the National Survey of Family Growth were analyzed (n = 10,223). Latent class analysis (LCA) was used to identify distinct classes of men's preconception health. Eight manifest variables were used to fit latent class models. A classify-analyze approach was subsequently used to create a preconception health phenotype (PhP) outcome variable. SDOHs (exposure variable) were assessed in four domains (rural/urban residence, health access, socioeconomic status, and minority/immigrant status) to predict class membership. Survey-weighted multinomial regression models were fitted to examine the association between the exposure and the outcome. Results: Three unique PhPs were identified (lowest risk (69%), substance users (22.9%), and sexual risk-takers (8.1%) from the LCA model. Health access, socioeconomic status, and minority/immigrant status were significant predictors of class membership but not rural/urban residence. Sexual risk takers were more likely to be uninsured (aOR: 1.25, 95% CI 1.02, 1.52), college-educated (aOR: 1.94 95% CI: 1.34, 2.79), and non-Hispanic Black (aOR: 1.99 95% CI: 1.55, 2.54) while substance users were more likely to have unstable employment (aOR: 1.23 95% CI:1.04, 1.45) and have a high school degree or higher (aOR 1.48 95% CI: 1.15, 1.90) than men in the lowest risk category. Conclusion: Social determinants may impact men's preconception health in ways that are not conventionally understood. These findings raise important questions about how preconception health interventions should be created, tailored, and/or retooled. Specifically, studies that examine the sociocultural and political contexts underpinning the relationship between social class, masculinity, and men's preconception health are needed to provide nuanced insights on factors that shape these outcomes.

Factors Associated With Sleep Quality in Hospitalized Persons With Dementia.

BACKGROUND: Factors associated with sleep quality have not been well examined in hospitalized older persons with dementia, who are at high risk for impaired sleep. The aim was to identify factors associated with sleep quality among hospitalized persons with dementia. METHODS: This secondary analysis used baseline data from a cluster randomized trial. Factors examined included delirium severity, pain, depression, behavioral and psychological symptoms of dementia (BPSD), and daytime physical activity. Multiple stepwise linear regressions evaluated factors related to dimensions of sleep quality (sleep duration, efficiency, latency, and fragmentation; measured by the MotionWatch 8). RESULTS: Increased daytime physical activity was associated with higher sleep duration [ß=0.164; 95% confidence interval (CI), 0.111-0.717; P=0.008; 7.7% variance] and sleep efficiency (ß=0.158; 95% CI, 0.020-0.147; P=0.010; 5.4% variance), and less sleep fragmentation (ß=-0.223; 95% CI, -0.251 to -0.077; P<0.001; 10.4% variance). Higher BPSD was significantly associated with prolonged sleep latency (ß=0.130; 95% CI, 0.098-2.748; P=0.035; 3.7% variance). CONCLUSION: Results suggest the need to encourage daytime physical activity and reduce or manage BPSD to improve sleep quality among hospitalized persons with dementia.

Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood.

Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one's health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.

Understanding factors that promote uptake of HIV self-testing among young people in Nigeria: Framing youth narratives using the PEN-3 cultural model.

It is important to understand how to frame the formats for promoting HIV self-testing to increase uptake among young people. In this study, we used a culture-centered model to understand the narratives of HIV self-testing preferences among young people in Nigeria. We conducted a crowdsourcing contest to solicit ideas surrounding HIV self-testing promotion among young people (10-24 years) in Nigeria from October to November 2018 as part of the 2018 World AIDS Day event. We received 903 submissions and employed thematic content analysis to evaluate 769 eligible youth narratives. Thematic content analysis of the statements from the youth narratives was guided by the PEN-3 cultural model to examine the positive, existential, and negative perceptions (beliefs and values), enablers (resources), and nurturers (roles of friends and family) of HIV self-testing promotion among young people in Nigeria. Several themes emerged as factors that influence the uptake of HIV self-testing among young people in Nigeria. Specifically, seven themes emerged as perceptions: HIV testing accessibility, stigma reduction, and autonomy (positive); HIV self-testing kit packaging and advertisements (existential); lack of knowledge and increased stigma (negative). Seven themes emerged as enablers: social media, school, and government promotion (positive); gamification and animation (existential); high cost and access to linkage to care services (negative); And seven themes emerged as nurturers: peer, families, and faith-based communities (positive); parents and family-centered approach (existential); and partners and family (negative). Our data suggests that increased awareness around HIV self-testing on current youth-friendly platforms, de-stigmatization of HIV and HIV self-testing, decreased prices for HIV self-testing kits, reliability of testing kits, increased linkage to care services, and promotion of self-testing among family members and the community will be beneficial for HIV self-testing scale-up measures among young people in Nigeria.